Weekly Health Tech Reads | 3/19/23

Privia & OhioHealth partner, a couple big funding rounds (Clever Care, Maribel, Diverge, Zus), & more

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News:

OhioHealth partners with Privia as its MSO partner for its clinically integrated network

OhioHealth will be leveraging the Privia platform to support independent providers in Ohio via OhioHealth’s clinically integrated network, focused on helping them move to value-based payments. Yet another sign of the (very logical) land grab that is happening in this market as providers across the board are looking at how to access additional payments via value-based care models. It’s worth noting here that OhioHealth also had partnered with ChenMed back in 2019 to launch de novo Medicare Advantage clinics, and so this seems like recognition from Ohio that the faster way to move into VBC is by leveraging an MSO platform that can enable VBC for existing practices. Obviously, the key question here will be whether Privia / OhioHealth can drive successful performance in VBC contracts within a CIN.

As we talked about in the Slack thread this week, it’s interesting to see how Columbus has become one of the hotbeds of primary care innovation in this country. Columbus is where agilon got its start via its partnership with Central Ohio Primary Care, and COPC also is working with Morgan Health and Vera Health on an employer-focused model. There are also a bunch of other initiatives discussed in Slack - including Cityblock, Optum, and others that are also involved in the market.

Link / Slack (h/t Teresa Breen)

Clever Care, a culturally competent MA plan, raised $42 million

Seems like a remarkable accomplishment for an insurtech startup to announce a funding round in this environment, between the struggles of the public insurtechs and the financial questions around the impact of 2024 advanced notice. Clever Care, which has ~11,000 members, has now raised $138 million. It’s interesting to note the round was led by GV, with Point32Health joining as an investor as well. Point32Health was created in 2021 as the parent entity for Harvard Pilgrim Health Care and Tufts Health Plan. Will be curious to see if the relationship between Clever Care and Point32Health expands over time here.

Maribel launches with $25 million and partnerships with Mercy and BAYADA

This week, Maribel launched a new hospital at home platform with Mercy Health as its first health system partner. It also announced a partnership with BAYADA, a non-profit home health provider. Maribel appears to be building the tech platform and operational infrastructure to enable its clinical partners, like Mercy and BAYADA, to implement and scale HaH models. It’s the latest in a string of news. The hospital at home market is really heating up after languishing for years as one of those healthcare innovation opportunities that seems so obvious but goes nowhere because of FFS financial incentives. Maribel was incubated inside of General Catalyst since 2021, and is led by former CEO of Mission Health, Ron Paulus.

Link (Mercy) / Link (BAYADA) / Slack

Diverge Health, a community health worker model for Medicaid, launches

Diverge launched to scale a community health worker model that acts as an extension of PCP practices to manage Medicaid patients. To do so, Diverge has acquired the IP of City Health Works, a non-profit community health worker model based in NYC. The City Health Works model appears to have had quite a positive impact on various communities in NYC, so it’ll be interesting to watch how it translates to a for-profit environment seeking scale.

Minnesota signs a new bill providing free breakfast and lunch to students

Minnesota becomes the fourth state to do so as it continues a program that was launched during the pandemic but was discontinued last year. As we collectively talk more and more about solving SDoH issues and innovation in the Medicaid space, it was a good reminder for us of the change that can be driven from a public policy perspective. Minnesota will spend $400 million over the next two years providing meals to kids.

Healthcare data platform Zus raised $40 million and announced its partnership with Elation

SpectrumAi, an EMR / analytics platform for ABA therapy for autism, raised $20 million

OpenLoop, a provider staffing platform for digital health companies, raised $15 million

Opinions

STAT highlights how NaviHealth is denying care on behalf of MA plans

It’ll be interesting to watch how public perception of Medicare Advantage trends over time as it becomes an increasingly politicized debate. This STAT article highlights how an algorithm seems to have wrongly led a payor to stop paying for care for a member. The algorithm in question was created by NaviHealth, now owned by Optum, and predicts when people are ready to leave a hospital / nursing home. As you might imagine, there’s not a lot of transparency into how the algorithm works, and this is frustrating for doctors who don’t agree with it.

The article includes some fascinating quotes from Tom Scully, the former CMS leader and NaviHealth investor. Scully highlighted the ambiguity around how we know whether organizations like Navi are doing “good” in the industry. Scully suggested he invested in Navi originally because it was designed to remove waste from the system and doing so correctly - a net positive for the industry, right? Nobody likes waste. But then Stat pressed him on how Navi seems to be used today to deny care, and his response was that he’s not involved anymore and doesn’t know what UHG is doing with it. Ok, understandable I suppose. But at the same time, when the core financial ROI generated by a business revolves around denying care, it seems fairly obvious that an insurer (that paid a hefty sum for the company) would use the tool for just that purpose, no?

Link / Slack (h/t Sam Stearns)

New Hampshire is dealing with maternity wards closing

This article highlights how a HCA-owned hospital has struck a deal to pay $2.75 million to close its labor and delivery service two years early in Rochester, VT. It’s creating an access issue in the state, which now has only 15 hospitals and 6 birth centers across the state. Eleven hospitals have stopped offering labor and delivery services in VT since 2000, and another birth center is slated to close this year. You can imagine why HCA made this decision financially, when it delivered less than 100 births in the past year. I’m not sure what the economics are for L&D but I can’t imagine it’s easy to run that profitably when you’re delivering two babies a week. In many ways, this highlights the tension in care delivery right now - if you scroll back up, you see a ton of for-profit investor interest in scaling local non-profit care delivery models nationally. But then access to healthcare becomes a question of profitability more than anything else, and we end up in scenarios where HCA is willing to pay millions to local non-profits to provide the services that it does not want to provide.

Link / Slack (h/t Sina Haeri)

KHN digs into why the US is a world leader in pre-term births

The article provides a nice summary of some of the issues our system has leading to ~10% of live births in the US being preterm, compared to 7.4% in England or 6% in France. Somewhat ironically given the article above, Vermont checked in as the best state in the US at only an 8% preterm birth rate, versus many southern states. Mississippi, for instance, had a preterm birth rate of 15%.

Duncan Reece highlights the ins-and-outs of the MA bid process

This is a helpful read outlining some of the nuances of the MA bid process, which is arguably the most important effort of the year for MA payors. During this bid process, payors set their benefits for the plans they will offer during the coming year. Those benefits are locked in for the year, meaning that if payors screw up during this process it has massive financial impacts on the orgs.

Data

A survey of 1,221 consumers on how they find and pick doctors

Tebra, the new parent company of PatientPop + Kareo, conducted the survey exploring how consumers think about picking their providers. It includes some interesting data about preferences and breaks down those preferences across generations. Helpful for care delivery orgs thinking about how to communicate with new / existing patients.

Link / Slack (h/t Paulius Mui)

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